Adaptations and Integration of Paddlers with Disabilities at Canoe Clubs

Transcription

1 Adaptations and Integration of Paddlers with Disabilities at Canoe Clubs 12/08/2009 1

2 1- ADAPTATIONS ->Special seats -> Back rest for everyone proposed by the boat manufacturers ->Adaptations «do it yourself» -> Amputee adaptations -> Upper limbs adaptations -> Floats -> Fitting out dock facilities 2- PATHOLOGIES : DESCRIPTIONS AND PRECAUTIONS 3- IMPORTANT TOPICS -> Precautions that should be taken -> Integration at the club -> Recommendations for events 12/08/2009 2

3 Why do we need to adapt the equipment? Comfort (facility) Security (for the paddler and the coach) Transmission Performance Integration 12/08/2009 3

4 ADAPTATIONS : special seats 12/08/2009 4

5 Adjustable seats Seat for amputee kayakers 12/08/2009 5

6 Seats designed by a prosthetist Pelvic abutment is very important for strength transmission and balance of the paddler 12/08/2009 6

7 Personalised seat design by a prosthetist Legs are resting on a long surface. Inclination of the seat toward the back is important to prevent spastic crisis 12/08/2009 7

8 USA Seats: 12/08/2009 8

9 Back rest for everyone proposed by boat manufacturers 12/08/2009 9

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11 12/08/

12 12/08/2009 Lumbar support for strength transmission and to compensate for lack of sheathing 12

13 ADAPTATIONS «do it yourself» 12/08/

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17 12/08/

18 Adaptation for amputees 12/08/

19 Use of a rudder by amputated leg 12/08/

20 Locking of an amputated leg is a must for balance, comfort, and strength transmission. 12/08/

21 Upper limbs adaptation 12/08/

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25 Muff to maintain the hand on the paddle 12/08/

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28 Help to maintain good prehension: 12/08/

29 Paddle with only one arm 12/08/

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31 12/08/

32 Clip the paddle to use only one arm 12/08/

33 The floats: 12/08/

34 Inflatable floats 12/08/

35 Accessibility to water Beach Hippocampe: 12/08/

36 Loading adjustments 12/08/

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38 12/08/

39 2- PATHOLOGIES a. Motors Chair: - electrical - manual para/quadra, CP, TC, evolutive (myopathies ) Walker: - Amputees LL/UL, hemiplegics, CP, para/quadra incomplete, others b. Visual deficiencies => total => partial c. Auditory deficiencies => total => partial 12/08/

40 Paraplegic and quadriplegic: METAMERIC SENSITIVE LEVEL: -Which one? -Complete or incomplete? - Functional consequences? SPASTIC PARAPLEGIA: spasms, hypertonia, uncontrolled reflex of defence. SPINELESS PARAPLEGIA: Weak muscles, amyotrophia, no osteo-tendinal reflexes. 12/08/

41 Paraplegic and quadriplegic: Peripheral neurologic handicaps NEUROLOGICAL LEVEL - Numbering = spinal column nerve vertebra - C5 to T1 = quadriplegic - Under T2 = paraplegic IN RELATIONSHIP WITH VERTEBRA ( IN GENERAL) - Cervical = quadri - Dorsal = para high - Lumbar=para low - Cauda equina = para low Paraplegic: palsy of the lower limbs, Coming up more or less high at the trunk level (according to the affected nerves) quadriplegic: affection going up to the upper limbs 12/08/

42 Paraplegic and quadriplegic: COMPLICATIONS and PREVENTION : Vesico-sphincteral troubles Vegetative troubles Skin complications Osteo-tendinal complications Spasticity increase 12/08/

43 Paraplegic and quadriplegic: CONCLUSION PARA/QUADRI : - Variable portrait - Ask athlete information on their handicaps - Rare specific complications in the practice of a sport - Main prevention (fatigue, tendinitis, spasms ) 12/08/

44 Hemiplegic : Palsy on one side of the body Encephalic lesion of the frontal lobe or of the connected neuron Damage hemisphere on the side opposed to the hemiplegic (IMC) AETIOLOGY : - crane trauma -ACV - tumours - infections - malformations - diving accident -Cerebral Palsy (CP) 12/08/

45 Hemiplegic : HEMIPLEGIC MAIN CARACTERISTICS : - Right or left - Complete or incomplete - Frequent brachium-facial predominance - Spasticity - Frequent associated troubles: sensitive troubles visual troubles language troubles epilepsy CRANE TRAUMA: - Neuropsychological - Epilepsy - Balance troubles - Orthopaedic troubles trouble Romain DIDIO / Cyril 12/08/2009 FOURNIER 45

46 CP (Cerebral Palsy): - Causes: cerebral suffering ante/during/ or post-natal ; premature (in general : lack of oxygen at birth: late breathing) - Non hereditary, non evolutive - Associated troubles: hypertonia abnormal movements disturbed motor pattern visual and auditory troubles spatiotemporal troubles epilepsy orthopaedic troubles different intellectual disease (1/3 of the cases) 12/08/

47 Amputees: - Aetiology : congenital, traumatic, tumoral - Lower limb(s), upper limb(s), poly-amputees - Improvement of the equipment - Problems at the stump(important hygiene) - Sport activity with or without equipment depending on the sport - Possible complications due to friction humidity, salted water 12/08/

48 Evolutive neurologic handicap : - Myopathy (Duchenne de Boulogne, Becker, ) breathing assistance orthopaedic problem heart condition - Heredo-degeneracy spino-cervical (Friedreich,Charcot-Marie ) - Spinal amyotrophy Evolutive handicap problems: - Aggravation with fatigue - Aggravation with settled way of life - Make compromise between physical activity and rest - Medico-technical assistance often needed - Sophistication of equipment - Psychological and social benefits play an important part - Do not propose long term objectives 12/08/

49 Visual deficiencies: - Aetiology : congenital, traumatic, tumoral - Precautions : frequent evolution of injuries fragility of eyeballs = avoid traumatisms frequency of falls and collisions watch water splashing depending on the cases. 12/08/

50 Auditory deficiencies : - Aetiology: chronic otitis cerumen plug otosclerosis otospongiosis: calcification that reduce mobility of the stirrup exposure to loud noises absorption of ear s toxic medication skull fractured deafness of transmission (extern and mid ear, never total) deafness of perception (intern ear) - Precautions : consider removal of auditory prosthesis watch impacts at the implant level 12/08/

51 3 IMPORTANT SUBJECTS * Discuss with the paddler: his/her pathology, his/her true-life sport, what he/she is looking for from sport activity. * The medical certificate and record of medical information (Abdos yes/no, level of fatigue, etc. ) * Importance of tipping (Remember, this can be fun!) * Watch for skin problems * Watch the weather (warm/cold) => problems of thermoregulation (paraplegic et quadriplegic) 12/08/

52 * Assess aspects related to possible incontinence: time on the water, bottle, catheter. * Assisting the transfer into the boat watch for the safety of the person and the one who is assisting. * Safety of adaptations: there should be no risk of jamming in case of wet exit (tip). Comfort and tipping : experiment with tipping, validation of tipping and of adaptations is common: discussion helper/paddler =>very important. Review all steps of the apprenticeship: wet exit, reloading, safety, choice of equipment 12/08/

53 IMPORTANT SUBJECTS AT THE CLUB LEVEL Be Welcoming: ensure the Club environment is accessible to everyone. Promote and communicate with other Club members Review the accessibility of the Club environment. Communicate with the participant: speak directly to the one involved. Promote long term participation adapted to the desire, capacity and pathology of the participants. Do not hesitate to call on local expert resources Opportunity for the Club to give back to the community 12/08/

54 RECOMMENDATIONS FOR COMPETITIONS - Appoint a person on the Organising Committee in order to coordinate all matters pertaining to the PaddleAbility races & all accessibility issues. - Parking spaces for persons with a disability should be convenient. -All access routes from the parking to accommodation, from accommodation to the regatta venu be accessible. This means a smooth access route which facilitates movement in a wheel-chair or crutches. - Ensure accessible washroom facilities. -A special loading area (the docks) is required (loading is longer and need more space due to wheel-chair). 12/08/

55 - The height of the loading dock at between 15 and 20 cm from the surface of the water with a minimum width of 1.50 m. - If there is a ramp to access the dock, the width should not be less than 1 m and the slope should be no more than 10 %. A guard/handrail should be provided on one side. - Schedule the races to begin no sooner than 10 am (to give the athletes a chance to get ready) - Provide an area to store the boats close to the dock. -A tent, close to the loading area, to store the garments and above all, the wheelchairs, the crutches and the prosthesis -Provide a tent and related facilities/equipment for a PaddleAbility athlete classification team 12/08/

56 CONCLUSION: BENEFITS OF PRACTICING CANOE/KAYAK FOR DISABLED PERSONS Physical aspects - Rediscovery of one s personal ability (feel one s own body under effort ) - Facilitate the use of muscular and functional compensations - Keeping and improving heart and breathing capacity - Balance development - Skill development Etc Socio-psychological aspects - Social integration into the life of the club - Feeling of being like all other persons on the water - Outdoor activity - Feeling of liberty (equipment non visible or absent) Etc => IMPROVEMENT OF AUTONOMY AND SELF ESTEEM 12/08/